Leadership in Action booking form

Applicant details

Compulsory questions are denoted by a *

Please give complete information. Do not use 'CAPS LOCK'.

This course is free and open to all postgraduate researchers and research staff.

Title: *: Other, Please specify

Forename(s): *

Preferred name: *

Surname: *

Age:

Address line 1: *

Address line 2:

Address line 3:

Town / City: *

Postcode: *

Country: *

Telephone number: *

Mobile number: *

Email address: *

Confirm email address: *

Gender: *: Please select
Male
Female

Postgraduate researcher or research staff: *: Postgraduate researcher (PGR)
Research staff (RS)

Department: *

University: *

If other please state:

Field of study : *

If other, please state:

If applicable, how is your research funded? : *

Dietary requirements:: Other, Please specify

Special needs:

If other, please state:

Do you have a disability?:: Please select
Yes
No

If yes, are there any special needs that we need to be aware of?:

Do you take any medications?:: Please select
Yes
No

If yes, please state if these need to be catered for in any way:

In case of emergency, please give the name and contact number for your next of kin: *

Cancellation conditions

A £100 deposit cheque will be required to guarantee your place on the course. Cheques will be held by Vitae and will only be cashed if you cancel your place less than four weeks prior to the course or if you fail to turn up on the day. Cheques will be returned on the last day of the course.

I accept your cancellation conditions: *

How did you hear about the Leadership course?: *

If other, please state:

What are your objectives for attending this course? (e.g. what you are hoping to get out of this course; your reasons for choosing to attend this course etc): *

Sign up for the Researcher Bulletin

Vitae Researcher Bulletin is an online newsletter intended for researchers (postgraduate researchers and research staff). It is distributed on an ad-hoc basis and contains useful resources and opportunities on your personal, professional and career development as a researcher.

If you would like the most upto date information on researcher development news and resources, and would love to be the first to know about any new courses and events open for booking - sign-up and be part of the Vitae researcher network.

Data Protection

By registering for this course, your details will be held on Vitae's database for administrative purposes only.

Your contact details will be stored in accordance with the Data Protection Act, and will not be passed onto third parties.

Please contact us if you have any feedback about the service you receive from us, or if you would prefer not be contacted by us in the future.

If you want to change your entry after submission, please do not apply again. Contact us or telephone 01223 448509.

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